The Maus in our Haus

As many of you know, our beloved Maus (also known as Sasha) underwent surgery last Friday for complete tooth extraction. So, we now have a toothless cat. Even writing that, I feel a bit of a churning in my stomach at having put her through such drastic surgery, but her story speaks for itself.

About a year ago in June, right around the time Michael and I bought our home, Sasha began refusing to eat her dry food. I assumed she was being a picky eater, and while I would give her canned food every other day or so, I didn’t take her to the vet. She also appeared outwardly healthy in all other aspects – her weight was good, her coat was shiny, and although she was shedding a bit more than usual it didn’t seem to be cause for concern. Within months, though, she rapidly deteriorated.

Whereas before she had been able to eat wet food easily, she began refusing any kind with “chunks” in it – only the pâté-style food would do. Soon after, around the time of our wedding in December of 2009, she developed the strange habit of eating, and then running away from her food very quickly – almost as if something was chasing her. I put that down to living with our other cat, Sophie. Sophie is a rambunctious little one, and Sasha is more of a quiet, reserved lap cat. It seemed that Sophie kept trying to eat Sasha’s food, and Sasha would run away. Again, I didn’t take her to the vet.

By March of this year we realized that something much more than picky eating or fear of other companion animals was going on – Sasha’s coat was dull, her skin dry, and when she ate she would occasionally howl in pain. It was the sort of noise you hear when stray cats are fighting, or when a cat’s paw or tail is shut in a door or recliner footrest. It was a sound of pain, pure and simple. After the first time we heard her make that noise, I scheduled Maus for a veterinary checkup as soon as they could see her – three days later.

I still have feelings of guilt when thinking of that appointment, because we discovered that Maus had gone from 11lbs to 8lbs 9oz since our last visit – a span of only four months. After we described the problem, our veterinarian examined Maus’ mouth and determined that she had rather advanced gingivitis and needed to be brought in to have her teeth cleaned thoroughly. We (the vet, Michael, and I) reasoned that inflamed gums were causing Maus pain, which was causing her to avoid food. At that appointment, Maus was given subcutaneous fluids and an injection of steroids to try and ease her pain while we waited for a time slot to open up for feline dental work.

That was a Friday, and on the following Monday we took her in for a tooth cleaning. In the afternoon, we got a call informing us that her teeth had been cleaned and that they’d had to remove five infected teeth while she was under anesthesia. I was surprised, but figured that with her infected teeth removed and her gums nicely cleaned, Sasha would no longer be a cat in pain. She was put on steroids and antibiotics, and we all assumed that the problem had run its course. Obviously, we were very wrong.

About a month later, once her steroids and pain medicine had run out, she began exhibiting the exact same symptoms – only worse. She was now afraid to go near her food dish, and would only eat if I put her on my lap and stroked her the entire time, creating a cave of sorts with my arms and chest and legs. Even then, after only a few bites she would yelp and run away to hide. I immediately called the vet, who speculated that one of the “sockets” from where her teeth were extracted had perhaps become infected.

When we took her in again, it was discovered that her gums were entirely inflamed – a bright, livid red and quite obviously painful to the touch. I was the only person who could touch her jaw without being swatted, so I had to open her mouth for the vet to examine her. She had also dropped from 8lbs 9oz to 7lbs 0oz – a loss of 20% of her body weight in just over a month. The vet vaguely mentioned that very rarely, there were cats who became “allergic to their own teeth”. She said that these cats sometimes were able to recover with medical rather than surgical intervention, and that while 80% of cats who had a total tooth extraction recovered completely, the surgery was too drastic to jump to immediately.

She also brought up the possibility of Feline Leukemia, and we spent an unmentionable amount of money on a FLV test. To our relief, it came back negative. It was decided that we should try an injection of a long-acting steroid, which would stay in her system for about three weeks. The thought was that this steroid would help Maus fight off the infection she was battling, and that combined with stronger antibiotics it would solve our problem.

Precisely three weeks after that appointment, the crying began again. Even with the steroids, she’d only been able to eat a pureed, soupy mixture of wet food and warm water. And now, she couldn’t even eat that. Another vet visit, another round of steroids and antibiotics, and another two weeks passed. By this time, Michael and I (along with our normal vet and the specialist we’d seen during an emergency visit) were convinced it was FLPS – Feline Lymphocytic Plasmacytic Stomatitis.

If you’ve never heard of FLPS (I know I hadn’t…), here’s a quick run-down:

“Feline Lymphocytic Plasmacytic Stomatitis (FLPS) is a severe inflammation of the entire oral cavity is cats. The gingival (gums) and entire oral cavity is swollen, red and very painful. Cats may cry out suddenly when eating or opening their mouth even to yawn. We had one patient that was so painful, he hissed at himself when he opened his mouth. Often the teeth do not look diseased. They may be pearly white, but the tissues surrounding them are seriously inflamed.

We believe that FLPS is a disease of the immune system wherein the cat is intolerant to the plaque bacteria on the teeth. Normal animals are able to handle the 750,000 bacteria present in each milliliter of saliva without signs or symptoms of disease. Cats that are affected by FLPS have a much exaggerated inflammatory response to the plaque bacteria. This severe inflammation causes the gingiva to be cherry-red in appearance and to bleed easily. Cats may approach their food bowl, but not eat because they are so painful. As a result affected cats may lose weight, become dehydrated and show other systemic signs of disease.

Cat owners may see very red gums that bleed easily, causing the cat to avoid eating, even when he is obviously hungry, or to eat only soft food. The physical signs of inflammation are clearly visible inside a cat’s mouth. What may be more noticeable to an owner, however, are behavioral changes; irritability, aggression, depression, excessive hiding, and poor grooming. Affected cats also may drool and have bad breath. A cat may cry when opening its mouth or eating.”

Additionally:

Surgical tooth extraction is often necessary to alleviate the pain FLPS cats experience. The rationale for this treatment is that the teeth harbor the plaque bacteria. By removing the teeth we are removing the plaque bacteria. However, even this treatment only addresses the symptoms — not the cause. We may suggest extracting the cheek teeth (premolars and molars) first, to see how effective this is in controlling the inflammation. A cat’s appearance changes very little with this procedure, because the front teeth (canines and incisors) remain in place. Eventually all teeth may need extraction. As veterinary dentists, we do not like suggesting this option, but sometimes the welfare of the patient necessitates it. Again, it is very important that all tooth substance is removed, since any fragments left behind can be a cause for treatment failure. Dental X-rays will confirm that this has been accomplished. Typically, once a cat has recovered from the surgery, he is able to eat remarkably well.

This treatment sounds drastic, but the results are often amazing. Most of the cats treated by extraction are eating hard, dry food within a week or two of surgery and sometimes even by the next day! These cats may have stopped chewing their food because of the pain. Treating the inflammation and thereby alleviating the pain allows them to eat comfortably again. Many cats gain weight, start to groom again and are much happier. Believe it or not, even with no teeth some cats will eat dry food by using the bony ridges of their palate.

However, even with all the teeth extracted, some cats will still have some inflammation that needs treatment. Continued medical therapy may help. Some cats are helped with laser therapy of the inflamed tissue; other may be helped with oral interferon, a drug used in human cancer therapy. There are many treatment protocols that have been tried and described and they all help some cats, but none have been predictably effective for all cats.

FLPS is a very frustrating disease for veterinarians, veterinary dentists, pet owners, and especially affected cats! Hopefully one day we will understand the cause of the disease and can target our treatment accordingly.”

So, on Friday of last week Maus went in to have every single one of her teeth removed. When we picked her up, I started crying – I’d never seen a more miserable animal. She was drooling blood, her eyes were glazed, and she didn’t want to move her head or jaw in the slightest. She’s been on buprenorphine and cyclimycin three times a day since then. We made our bedroom into a haven for her, blocking off the cat door so that she could be completely alone and undisturbed by our overly-playful cat and dog and moving a cat box, her food and water, and her favorite shirt of mine into the room for her. She spend the majority of the next three days curled up in a ball, tucked between our pillows and burrowed under my red flannel shirt. She was amazingly affectionate throughout this time, seeking comfort and attention every time I was in the room.

Michael chose to sleep on the futon rather than force Cricket to sleep in her cage all night, so at night it was just Sasha and I. She didn’t leave my side for a minute. Even when we re-opened the cat door so that she could get out if she wanted but still keeping the dog away from her space, she didn’t want to leave. Maybe it was the pain medication, which can make even people much more affectionate, but I soaked up the time with her. Since Michael moved in with me in 2008, Sasha had stopped sleeping with us – she used to burrow under the blankets and sleep curled up against my stomach for the entire night, no matter how much I fidgeted.

The most beautiful news of all, however, is that last night Maus ate dry food! She hadn’t eaten dry food since December of 2009, and now our toothless cat is happily gumming one kibble at a time from the palm of my hand. It was so very encouraging last night, to see her eating normally (or at least as close to normal as she’s been in a long time). She’s also been more playful, consistently affectionate, and generally much more relaxed. She’s grooming herself again (she’d stopped about a week prior to her surgery) and her coat is shiny and beautiful. It’ll be some time yet until we have her back up at her healthy pre-FLPS weight, but I have very high hopes for our Mauser 🙂

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